Healthcare Provider Details

I. General information

NPI: 1740854686
Provider Name (Legal Business Name): EASTERN CONNECTICUT PATHOLOGY CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 CROMWELL AVE STE 201
ROCKY HILL CT
06067-3454
US

IV. Provider business mailing address

71 HAYNES ST
MANCHESTER CT
06040-4131
US

V. Phone/Fax

Practice location:
  • Phone: 203-996-8125
  • Fax:
Mailing address:
  • Phone: 203-996-8125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DENNIS O'NEILL
Title or Position: PRESIDENT
Credential: MD
Phone: 860-647-6487